Rebecca Hendren, for HealthLeaders Media, October 26th, 2010
There's no substitute for experience, especially in nursing. Experienced nurses accomplish all their tasks in a shift and somehow their patients never know how busy they are. They still find time to check in, offer support, and even a shoulder to cry on.
Nurses who know the ropes understand how the system works. They can communicate ably with physicians, pharmacists, nursing assistants, patients, and families and are the glue that holds "multidisciplinary care" together. They can take one look at a patient and know "something's just not right," fixing a problem before it degenerates.
Finally, nurses with experience are role models and mentors for new nurses, helping the next generation become experts and passing along their wisdom. So it behooves healthcare facilities to retain these nurses as long as possible.
But experienced nurses are aging and exiting the workforce. According to data recently released from the latest National Sample Survey of Registered Nurses—which has been conducted by U.S. Department of Health & Human Services Health Resources and Services Administration every four years since 1977—the average age of licensed RNs is 47. Nearly 45% of RNs were 50 years of age or older in 2008, a dramatic increase from 33% in 2000 and 25% in 1980.
Because of this looming crisis as experienced nurses retire, the Robert Wood Johnson Foundation launched a national program in 2006 called Wisdom at Work: Retaining Experienced Nurses. The idea was to find out what will keep experienced nurses in hospital settings and find out what effect existing interventions have on the work environment for older nurses.
Through this program, 13 initiatives were evaluated that were intended to retain experienced nurses, which fall into three categories:
- Ergonomic projects, such as lift teams and anything that reduces the physical burden of nursing
- Human resource strategies to improve organizational culture
- Strategies that involved employee wellness, clinical technology, or leadership development
While no single initiative or strategy has been identified as a silver bullet, the program has found several strategies that when combined with an organizational culture that values experienced workers and leadership support create an environment that encourages experienced workers to stay.
Successful strategies include:
- Closed staffing: A model that keeps nurses on their home units rather than assigning them to other units as needed.
- Giving experienced nurses more control over patient flow, discharge and admission.
- Staffing for frequent peak occupancy rather than average occupancy.
- Wellness at work programs that promote wellness through incentives, fitness center memberships, and other components.
- Virtual ICUs that allow experienced nurses to use computers to monitor ICU patients at multiple sites.
- Renewing and reframing older nurses' practices, such as the three-day, off-site educational experience that rewards experienced nurses with an opportunity to renew their nursing practice.
- Patient lifting devices and other labor-saving technologies.
- Centralized workstations and decreased need to walk long hallways.
- Increased scheduling flexibility.
- Developing new career paths.
The hospitals that retain experienced nurses are the ones that include targeted benefits such as:
- Phased retirement options
- Flexible work scheduling
- Eldercare benefits
- Transfers to new roles (such as from bedside nursing to clinical mentoring)
- Gain-sharing (compensation based on organizational performance, such as exceeding patient satisfaction or financial performance targets
The RWJF project is still ongoing and gathering data, but its results so far have shown that hospitals committed to managing and developing talent are the hospitals where nurses want to work.